AIDS at 30: Lessons Learned

This year marks the 30th anniversary of the HIV/AIDS global epidemic that fundamentally changed medicine, public health, international development and international affairs. Over those 30 years the disease has led to more than 60 million HIV infections and nearly 30 million AIDS deaths. According to the UNAIDS latest report, 34 million people lived with HIV in 2010. At least 1.8 million died of AIDS in 2009. Despite massive global efforts against HIV transmission, 2.6 million became infected in 2009, including 300,000 newborns.

AIDS has significantly degraded national economies. It has stretched family systems to breaking points in resource-poor settings, worsening the plight of women, the underclass and the disenfranchised.

In rich countries, AIDS forced health and development bureaucracies to embrace the role of activists and civil society at the highest level of policy making. In poor countries, sustained activism forced political leaders to scramble for more HIV treatment options, to increase funding for the health sector and to hold public discussions about very private issues. AIDS metamorphosed from a narrow concern of infectious disease experts to a global movement, bringing together clinicians, public health experts, scientific researchers, street savvy activists, social scientists, economists, politicians, anthropologists, media practitioners, entrepreneurs, celebrities, and people living with the disease. As a result, global health today has one of the largest, most diverse coalitions in history.

Political

AIDS has shown that health is a political issue and that leadership is critical. For a long time, students in medical or public health schools were often taught to shun politics and to focus on meeting the needs of patients and target populations. Ministers of health were not expected to participate in politics. AIDS changed that, becoming a premier political issue of our time.

The United Nations Security Council broke new ground when it hosted its first meeting on AIDS in 2000. This was followed by the unprecedented 2001 U.N. General Assembly Special Session on HIV/AIDS. A unique U.N.-government-business-civil society technical alliance known as the Global Fund was created by former U.N. Secretary General Kofi Annan in 2002 to marshal the fight against AIDS. The U.S. government launched a global program against AIDS in some of the hardest hit countries. Presidents and prime ministers had some of their finest hours in office in the last 15 years speaking about and doing something for AIDS. The World Health Organization reasserted itself as the premier global health agency when it launched an ambitious HIV/AIDS treatment program in resource-poor settings.

Winning and losing

AIDS has shown that you can both be winning and losing a war at the same time. According to UNAIDS, impressive strides have been made against the disease. The rate of new HIV infections declined by more than 20 percent in the last decade. The proportion of HIV-infected pregnant women receiving treatment to prevent transmission to their newborn babies increased from 35 percent in 2007 to 53 percent in 2009. More than 5.2 million individuals are now on lifesaving medicines compared to 700,000 in 2004.

However, heartbreaking shortcomings remain in the fight against AIDS. For every person started on HIV treatment, two or three new individuals become infected. At least 7,000 individuals become infected with HIV every day worldwide. A newborn contracts HIV nearly every minute, and someone dies of AIDS-related death every 25 seconds. Ten million individuals qualified for HIV treatment are yet to benefit despite the availability of lifesaving medicines.

The quest for an HIV vaccine remains years away even with significant, sustained investments. HIV preventive efforts continue to fall short. Sub-Sahara Africa remains the epicenter of AIDS, accounting for 68 percent of global HIV infections and 72 percent of all AIDS deaths, although it represents only 10 percent of the global population. Stigma and discrimination against individuals living with HIV/AIDS remain active in many countries. UNAIDS estimates that in 2010 the fight against AIDS was short by $10 billion. The slowdown in donor contributions to the fight against AIDS mirrored lingering global economic woes.

Women

The feminization of AIDS remains. The situation is dire in Sub-Sahara Africa, home to 76 percent of all women living with HIV in the world. Girls and women ages 15 to 24 are particularly at risk, with HIV infection rates three times that of male peers. Sadly, less than 50 percent of countries that report AIDS data to UNAIDS have programs targeting women at risk of or living with HIV. In addition gender-based cultural and societal norms and practices that may put women at risk of HIV infection are yet to be significantly challenged, politically and legally, in many hard-hit countries.

Community

Community-based programs remain the last stand on AIDS. After 30 years, the fight against AIDS is showing clearly that it will be won or lost at personal, family and community levels. Community-based programs are indispensable in regard to timely access to preventive, treatment, social and rehabilitative services. Unfortunately, HIV/AIDS community-based programs, including outreach services, remain mostly underfunded, ill equipped and poorly staffed.

I hope that 30 years from now, AIDS war stories will be about a vanquished global epidemic. However, today, the life and death struggle against AIDS remains a formidable challenge.